The Evidence Against Backboards and the Excess Use of Oxygen.

[paratrooper75 41]

It's time EMS writes it's protocols based off evidence based research and not just because "that's how we've always done it". I've included two links that show the effects of the excess use of oxygen and why backboards are overused.

Overuse of backboards:

http://mobile.emsworld.com/article/10964204/prehospital-spinal-immobilization

Excess use of oxygen:

http://rc.rcjournal.com/content/58/1/86.full

[newsbuff 286]

I will stop using a backboard when I won't get fired for not using it.

[sympathomedic 383]

Like, well over a decade ago, Empress did a study with State and REMAC approval of the "Maine protocol". Everyone had to take a few hours of class, get a small book and take a test. They gave us check sheets to use when we actually employed the protocol in the field, and they were collected.

Like I said, over a decade ago, but we reduced c-spine immobilizations by 15-24%, and had no bad outcomes. After the study period ended, Empress asked for and was granted permission to continue using the protocol. Many of those folks who were trained have left over the years, though.

Items that would require the board:

Intox, neck and back pain, distracting injury, cannot communicate, acute stress reaction, real mechanism.

Then: pt had to hold fingers apart while EMT pushed them together- pt had to resist.

Pt had to have sensory to toes, and to be able move feet from a laterally rotated to a center-line position while EMT offered resistance.

Lastly, EMT had to (really) palp the entire spine, skull to butt and find no tenderness or anatomical irregualrity.

So the lady who hits her head on the nightstand, and the guy who gets hit from rear at the light, the trip-and-fall, hit by ball etc would all get ruled out for c-spine IF they passed the other items. I have no idea why this did not become the law of the land. I agree with news buff. So many great ideas that we cannot do on our own discretion, because, alas, we are merely technicians.

[FireMedic049 597]

If you really think about it, a lot of what we do, particularly at the ALS level for most patients is not truly driven by medical benefit, but fear of litigation and/or the rare chance that a stable patient might "crash" for essentially an unknown reason. I've started countless IVs over the years for really no reason other than the protocol says I have to and the ER nurses will get pissy if I don't do it.

I've had to board far too many patients just because. Fortunately my state modified our immobilization protocols a few years ago to allow for more provider discretion and common sense in deciding who gets boarded and who does not. For the most part, if the patient doesn't have pain and a significant mechanism isn't involved we can avoid boarding them. Very helpful for the elderly "hatchbacks" that take a minor stumble.

[antiquefirelt 994]

Like, well over a decade ago, Empress did a study with State and REMAC approval of the "Maine protocol".

Sounds very similar to what....Wait a minute...yep, that is what we've been doing (in Maine) for years.

Items that would require the board:

Intox, neck and back pain, distracting injury, cannot communicate, acute stress reaction, real mechanism.

No real changes, we do the R/O "tests" and as long as they're deemed a reliable patient, they can be ruled out. We still have claims that we overuse backboards though. Of those we do board, 75% of the time we leave the hospital with the board, it's often the first thing the Doc does.

Then: pt had to hold fingers apart while EMT pushed them together- pt had to resist.

Pt had to have sensory to toes, and to be able move feet from a laterally rotated to a center-line position while EMT offered resistance.

Lastly, EMT had to (really) palp the entire spine, skull to butt and find no tenderness or anatomical irregualrity.

We also did/do a push up and push down with the feet against hand pressure to find pain.

In the end the real issue now comes to determining the reliability of the patient. Of the BS injuries that get boarded, 99% of them involved intoxication, thus every drunk that goes boom gets the full treatment, meaning they're drunk and pissed.

[STAT213 332]

New Hampshire will likely be eliminating the routine use of backboards in the next few months. Only reason to transport someone on one will be to restrain them. Suh-weet!!!!

Here's a quote from the draft of the protocol :

Long backboards do not have a role for patients being transported between facilities

And another:

Once the patient is moved to the stretcher, remove any hard backboard device by

using log roll or lift-and-slide technique.

AWESOME. Also, no more KED's or short boards. Period.

I cannot wait for this roll out. Timeline is still not certain, but they are working on getting it to us ASAP.

Edited November 13, 2013 by STAT213

[antiquefirelt 994]

New Hampshire will likely be eliminating the routine use of backboards in the next few months. Only reason to transport someone on one will be to restrain them. Suh-weet!!!!

Here's a quote from the draft of the protocol :

Long backboards do not have a role for patients being transported between facilities

And another:

Once the patient is moved to the stretcher, remove any hard backboard device by

using log roll or lift-and-slide technique.

AWESOME. Also, no more KED's or short boards. Period.

I cannot wait for this roll out. Timeline is still not certain, but they are working on getting it to us ASAP.

How does one get the pt. to the stretcher without using KED's or shortboards when the long board won't fit? Seems like some way of minimizing lateral spinal movement would still be necessary between the position found and the stretcher?

Very interesting stuff!

[sympathomedic 383]

I saw a stat that Australia immobilizes 10% of the patients we do, yet they have no higher incidence of traumatic paralysis. Maybe they have 10% of the lawyers we do?

I read another one that some very high %, like 70%, of all IV locks established in the field are not used for anything.

Then again, how many hose lines are stretched and not used either? A lot of what we do is just in case. Of course an unused hose does no damage. But an unneeded IV lock is a possible casue of infection, and a board can cause all the bad stuff cited in the study.

[v85 212]

My region in NY also has a spinal rule out protocol (HVREMSCO) how much it is utilized is another question.

Also, when I was taking my EMT class, we were still being told that everyone gets high flow 02 via NRB. The agency I ride with however makes use of the SpO2 meter, and will probably be getting ETCO2 meters when it is approved for BLS use; and we do titerate the O2 levels to patient presentation and sat.

[STAT213 332]

How does one get the pt. to the stretcher without using KED's or shortboards when the long board won't fit? Seems like some way of minimizing lateral spinal movement would still be necessary between the position found and the stretcher?

Very interesting stuff!

Two options

1)They move themselves. They get out of the car and lie down on our stretcher.

2) You use a long board, scoop, vacuum mattress or other full length extrication device. To quote the draft again : "Do NOT use short board or KED device."

Also, no more standing take downs. Eliminated from protocol.

Talk about going against everything we've done for years, huh?

Edited November 14, 2013 by STAT213

[antiquefirelt 994]

Two options

1)They move themselves. They get out of the car and lie down on our stretcher.

2) You use a long board, scoop, vacuum mattress or other full length extrication device. To quote the draft again : "Do NOT use short board or KED device."

Also, no more standing take downs. Eliminated from protocol.

Talk about going against everything we've done for years, huh?

Like most providers I see this as a large step in the right direction or at least toward evidence based medicine, but old habits and lessons are hard to erase, thus some trepidation rises for the things we used to fear so much like not minimizing spinal injury. Interesting that they specifically do not allow KED's and shortboards, clearly some stats and evidence must have shown greater issues from their use? The amount of spinal movement that can occur moving someone from seated (behind the wheel) to laying on a board is where I have pause, seeing shoulders turned one way while the hips don't move? What happens when the pt. has a sudden pain upon moving? These are the types of questions I'd wish to have answers to, before the situation occurs, so we can explain away the "I once was an EMT" bystander or the avid Chicago Fire fan convinced you've just further injured the victim.

Again, these questions are not to find fault with such changes, merely to have answers before the questions.

[STAT213 332]

I'm not familiar with what evidence was presented to our medical control board to push these changes. I know they are doing their best here to use evidence based medicine for as many of the protocols as possible. I do know that previous changes have included references for those of us with minds that need to know.

[medic25 0]

New Haven, CT eliminated backboards for ambulatory patients within the past year, and we are very close to having this policy adopted state-wide.